Madison County is one of the healthiest counties in the state in terms of health risks and outcomes, according to a medical study released Monday.

Among Kentucky’s 120 counties, Madison is ranked the 20th healthiest in “The Health of Kentucky: A County Assessment” by the Kentucky Institute of Medicine.

“We’re delighted to see this study,” said Jim Rousey, public health director for the Madison County Health Department. “It fits nicely with things that we’ve done. It will be helpful in helping to see where we need to go and what we need to do to improve on the rankings.”

The top 10 most healthy counties in the state in order are: Oldham, Boone, Jessamine, Anderson, Woodford, Fayette, Spencer, Daviess, Calloway and Clark.

The least healthy counties in descending order are: Owsley, Powell, Hart, Knott, Lee, McCreary, Perry, Harlan, Clay and Wolfe.

The study says most of the health problems in the state are because of poor lifestyle choices, such as tobacco use, unhealthy diets and not enough exercise.

“We’re you’re talking about a lifestyle change, it’s really tough,” said Carla Baumann, director of nursing for the health department. “I think that’s where we have an opportunity to identify better ways to have an impact on behavior.”

The study also said a lack of physicians and health insurance contribute to the poor health of Kentuckians — especially those in eastern Kentucky, the poorest region in the state.

“If you look across the state, the five leading causes of mortality are pretty much the same with the exception of just a very few,” Rousey said. “If you look at a county that has a better graduation rate and the median income is a little bit higher than most counties, then I think that relates to their state of health.

But, we have the same causes of death as Oldham County (the healthiest) and Wolfe County (the least healthy.) We have the same lifestyle issues with smoking, overeating and not getting enough exercise.”

According to the report, Kentucky is “a healthy place to live and work.” But Kentucky fares worse than the rest of the nation in terms of smoking, obesity, exercise and oral health:

• 29 percent of Kentucky adults smoke compared with 21 percent nationwide.

• 29 percent of Kentucky adults are obese, compared with 24 percent nationwide.

• 32 percent of Kentucky adults don’t get enough exercise, compared with 24 percent nationwide.

• 37 percent of Kentucky adults are missing six or more teeth, compared with 33 percent nationwide.

The study concluded that Madison County’s strengths include: good oral health; low motor vehicle deaths; high graduation rate; well insured; availability of primary care physicians, low diabetes, low lung/bronchus cancer rate and low colorectal cancer rate.

A low percentage of smokers also was a strength, according to the report.

Even though the Madison County Board of Health recently passed a regulation banning smoking in public places, Rousey said a team of people has been active for nearly 10 years teaching about the dangers of smoking.

“In that first year, they started giving a little play called ‘Huff and Puff’ at the elementary schools,” he said. “It showed the Big Bad Wolf unable to blow houses down because he was a smoker. I know that every time they gave that class that it impacted at least one person to not smoke or to delay smoking.”

The challenges Madison County faces, according to the study, include obesity, low birthweight, infant mortality, breast cancer and prostate cancer.

The county also has some of the state’s highest rates for cardiovascular deaths, according to the study, which attributes the cause to be “possibly related to the size of the county’s older patient population.”

In the behavioral/social factors section of the study, Madison County is below the state and national average in oral health (22 percent of adults missing six or more teeth), drug arrests (642 per 100,000 population) and occupational fatalities (two per 100,000 workers).

The number of motor vehicle deaths (.9 per 100,000,000 miles driven) in the county also is below the state and national averages.

“In a county the size of Madison County with the amount of traffic we have, our motor vehicle deaths are significantly lower than the state,” said Christie Green, administrative services manager of the health department. “We do have a very active Safety Coalition that has focused on seat belt usage and child passenger safety seats.”

The prevalence of youth smoking (23 percent of high school students) and the lack of physical activity (24 percent of the adult population) is tied with the national average, but lower than the state average.

The prevalence of smoking (26 percent of adult population), the prevalence of obesity (27 percent of the adult population) and the number of violent crime offenses (869 per 100,000 population) are above the national averages.

The 80 percent high school graduation rate in the county is tied with the nation and eight percentage points higher than the state average.

The per capita personal income in Madison County is $31,550, compared with the state average of $27,625.

Thirteen percent of the population under 65 years old in Madison County is uninsured compared with the state and national averages of 15 and 16 percent, respectively.

The total number of cancer deaths (226 per 100,000 population) and premature deaths (8,305 years lost per 100,000 population) were well above the national average, but below the state average.

Two areas that health department officials see as positive steps include prenatal care and immunization coverage.

Eighty-eight percent of Madison County women had adequate prenatal care — 13 and three percentage points higher than the national and state averages, respectively.

“This is an area that we have put significant effort and time into since 1984,” Baumann said. “It came with the recognition that people were coming in for delivery with no prenatal care. Since then, we have been in a partnership with Pattie A. Clay (Regional Medical Center) to provide prenatal care through the midwifery service. That’s been a success story.”

The percentage of children 19 to 35 months with immunization coverage in Madison County (83 percent) also was above state (80 percent) and national (81 percent) averages.

“We send staff out to the child care centers to do an assessment of their immunization status,” Baumann said. “We’re only required to make sure they get the survey and make sure they complete it. But, we go in to work closely with the staff to follow up to make sure the children are getting their vaccinations.”

Ten years ago, the health department only had three school nurses in only in a few schools throughout the county, Rousey said.

“Now, the total (school nursing) team is at 19 members, and we’re in all of the public schools,” he said.

Recommendations from the study for Madison County include increased community emphasis on regular primary care visits and screenings to help lower death rates for breast, prostate and other forms of cancer.

Improved nutrition and increased physical activity also can help reduce obesity and lessen the risks for diabetes, heart disease and other illnesses, the report stated.

To read “The Health of Kentucky” report, go to www.kyiom.org.

Bryan Marshall can be reached at bmarshall@richmondregister.com or 624-6691.